Common Lung Diseases — Overview and Investigations by lecturio

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This article should provide an overview of the main type of diseases that affect the lung. You will find a description of the important diagnostic tests used for investigating respiratory diseases, like general principles, emphasis on lung function testing role and interpretation and examples of diagnostic testing approach for some common presentations.
lung diseases
Range of lung diseases

The Big 4 Lung Diseases

  1. COPD — most common cause of acute medical admissions
  2. Asthma — most common chronic respiratory disease
  3. Lung cancer — most common fatal cancer in the Western world for both men and women
  4. Pneumonia — most common serious infectious disease

Other common respiratory diseases

Range of Lung Diseases

Diseases of the airways

Upper airway obstruction
Lower airway obstruction
Airway infection
Airway tumors
  • Lung cancer: squamous and small cell
  • Rarer tumors, e.g., carcinoid, metastases
lung diseases-range
Range of lung diseases

Lung parenchyma (alveoli and interstitium)

Infections
Interstitial Lung Diseases
Adult respiratory distress syndrome
Parenchymal tumors
  • Lung cancer: adenocarcinoma
  • Pulmonary metastases

Circulation

Pulmonary emboli (PE)
Pulmonary hypertension
  • Cor pulmonale
  • Chronic PEs
  • Other causes
Hemoptysis
Vasculititis
range-of-lung-diseases
Range of lung diseases

Pleural diseases

Pneumothorax
Pleural infection
Pleural malignancy
  • Primary: mesothelioma
  • Secondary: metastases

Other

Diseases of physiology
Iatrogenic lung disease
  • Procedure related
  • Caused by drugs
  • Associated with radiotherapy

Investigation of Lung Disease

Different Causes of Large Airway Obstruction

Acute upper airway obstruction

Speed of onsetCauseClinical presentation
SuddenAspiration of foreign body Mucous plugVery acute dyspnea and stridor
AcuteEpiglottis/ tonsilar abscess
Diphtheria
Smoke inhalation
Deteriorations of subacute/ chronic causes
Acute dyspnea and stridor
Saliva drooling
Fever (infective cause)

Chronic upper airway obstruction

Speed of onsetCauseClinical symptoms and signs
Subacute/ progressiveCancer: lung/ larynx/ thyroid
Benign tracheal tumors
Massive mediastinal nodes
Vocal cord paralysis
Progressive/ positional dyspnea
Cough
Hemoptysis
Stridor (can be intermittent)
Post obstructive bronchiectasis
Dysphagia (esophageal invasion)
Pain (malignant causes)
Chronic/ non-progressivePost-intubation tracheal stenosis
Post-infective, e.g., tuberculosis
Goiter
Previous upper airway surgery
Vasculitis
Tracheomalacia

Large Airway Obstructions: Clues

  1. ‘Squared off’ flow volume loop of tracheal obstruction
    Minimal variability in peak flow/ spirometry
  2. Positional symptoms rather than diurnal
  3. Inspiratory wheeze (Stridor)
  4. Past history of intubation/ tracheal disease
  5. Characteristic flow volume loop
  6. Fall in PEFR relatively greater than fall in FEV1

Bronchoscopy

  • Visual confirmation
  • Biopsies to confirm the cause (but can bleed…)
  • Treatment as well

Treatment of acute presentation

  1. Sit the patient up
  2. High flow oxygen or heliox (mixture of oxygen and helium) via mask
  3. Intravenous high-dose corticosteroids (reduce edema around obstruction)
  4. Nebulized salbutamol and adrenaline
  5. Intravenous fluid replacement
  6. Potentially urgent intubation or tracheostomy or bronchoscopy intervention

Treatment of chronic obstruction

Chronic—relieve the obstruction by
  1. Treat underlying cause if possible
  2. Bronchoscopic interventions e.g.
    • Stents
    • Laser ablation
  3. Surgical interventions
    • Remove cause
    • Tracheostomy

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